1033426143 NPI number — JOHNSON DRUG COMPANY, INC

Table of content: (NPI 1033426143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033426143 NPI number — JOHNSON DRUG COMPANY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON DRUG COMPANY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JOHNSON HOME MEDICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033426143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 NEW BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28540-5435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-347-5185
Provider Business Mailing Address Fax Number:
910-347-9298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8207 MARKET ST
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28411-8889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-686-2988
Provider Business Practice Location Address Fax Number:
910-686-3017
Provider Enumeration Date:
09/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MEDLIN
Authorized Official First Name:
DWIGHT
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
910-347-5185

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  00998 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)